| NPI | 1619351467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A144010) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35136308) |
| 207W00000X Ophthalmology (Licence: KY 52501) | |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2020-08-06 |